It happened again last week. A patient contacted me via Twitter with a clinical question about her child. As always, I never engage patients in the social media space. When they try to initiate an online encounter I track ‘em down immediately to let them know the safe of social media and our relationship.

Here are a few things I think about when discussing the matter with patients (or parents):

1. Take the discussion offline. All dialog concerning attempts at online contact are done by phone or in person.

2. Understand they’re just looking for help.Keep in mind that when patients try to reach you via Facebook they’re just looking for help.Twitter and Facebook are now becoming standard means of interaction so why would it be so strange to contact your doctor?In my dialog with patients who have crossed the line I try to approach the issue in a way that respects where they’re coming from.

3. Give them the facts. While I’m not a lawyer, I do my very best to discuss the importance of online health privacy. Social media is for casual conversation, not privileged health information. While we will likely see the proliferation of secure social media platforms for doctor-patient communication in the future, we’re not there yet.

4. Remind them you’ll get in trouble. When I remind parents that they’re going to get me in trouble they feel bad. I don’t want to make anyone feel bad but they have to understand the potential gravity of the situation when it comes to the law, state licensing bodies and hospital privacy.

5. Point out why social media represents a risky means of communication. After detailing how I could find myself in hot water, I then try to illustrate how social media isn’t built for patient care. Among other things it’s not easy to follow what happens between a practitioner and patient on a social application. Who said what or, more importantly, was the intended plan even understood by the patient? And how do you and other members of the healthcare team refer to a plan of care? Very high tech but very sloppy.

6. Document everything.Any attempt by my patients to discuss clinical matters via Twitter or other platforms is immediately documented in the patient’s medical record.I also document that I have discussed with the patient or family the appropriate ways to contact me.

7. Make a social media policy of your own. One way to keep your patients from reaching out to your online is by creating an office social media policy of your own. Rules of engagement via social media should be just as important as on call or billing procedures. Along those lines I occasionally post friendly online reminders that public discussion of care with health professionals isn’t appropriate. I keep a few clipped screen shots of thes  posts in the event that my social medial judgment is ever called into question.

8. Block repeat offenders. Patients who don’t understand the importance of health privacy represent a risk to themselves and a major liability to you. Offer one warning and block after that.

As physicians we have the responsibility to help patients understand what isn’t always obvious. And teaching the pitfalls of online health dialog fit with that responsibility.